Chapters in the History of the Insane in the British Isles

by Daniel Hack Tuke

To enter into much detail is impossible. It must suffice to say that case after case of gross neglect and cruelty was brought to light; that while 365 patients had died, only 221 had been reported; that a patient having been killed, his body was hurried away to prevent an inquest; that when the accounts were examined, it was discovered that two sets of books of receipts were kept, one of which was only presented to the governors, and that the difference between the sums contained in the two, amounting to some hundreds a year, found its way into the pocket of the superintendent; and lastly we must record that one wing of the asylum was burned, involving the deaths of patients and the destruction of much that it was with good reason believed the authorities wished to conceal.

Of the revelations made by the Committee of the House of Commons in regard to Bethlem Hospital, we shall only briefly speak. We have already sketched the history of this institution. For the most part it is to the second Bethlem—that in Moorfields—the minutes of evidence refer. During the seven years prior to the investigation, the number of patients averaged 238; the annual expenditure, £12,000. Mr. Haslam, the resident apothecary, ruled supreme. He was responsible for the dreadful condition in which the notorious Norris was discovered. "There is," says Sydney Smith, "much evasive testimony, to shift from himself the burden of this atrocious case; but his efforts tend rather to confirm than to shake the conviction which the evidence produces.... The conduct of Haslam with respect to several other patients was of a corresponding description; and in the case of a gentleman whose death was evidently accelerated by the severities he underwent, and of several other persons, there is abundant proof of cruelty.... It is in proof that a patient actually died, through mere neglect, from the bursting of the intestines, overloaded for want of aperient medicine, and it is expressly stated by Haslam himself that a person whom he asserts to have been 'generally insane and mostly drunk,' whose condition, in short, was such 'that his hand was not obedient to his will,' was nevertheless retained in the office of Surgeon, and continued to attend the patients for a period of ten years—a statement so atrocious that, from any other quarter, we should have rejected it as utterly incredible."[145]

The governors easily convinced themselves that no foundation whatever existed for the charge of cruelty and bad management; that every degree of permissible indulgence had been observed; that the hospital was equal, if not superior, to any other asylum in England; that the mode of confining the unhappy Norris appeared "to have been, upon the whole, rather a merciful and humane, than a rigorous and severe imposition;" in short, that "the general management of Bethlem, as affecting the health, the cleanliness, and the comfort of the patients, was of a nature creditable to the governors and others concerned in its administration." What a picture of the standard of excellence held by the managers of asylums at that period, not in Bethlem alone, but generally!

To the question, "Has there not been a rule in the hospital, for a certain number of years, that, in certain months of the year, particular classes of the patients should be physicked, bled, bathed, and vomited, at given periods?" the reply from Bethlem was in the affirmative. Twice in the year the patients, with few exceptions, were bled. "After they have been bled," said the physician, in evidence, "they take vomits once a week for a certain number of weeks; after that, we purge the patients. That has been the practice, invariably, for years—long before my time."

In regard to the means of coercion employed, it was stated that the patients "are generally chained to the wall with manacles." When inquiry was made regarding the use of strait waistcoats, it was replied, "I do not believe there are any strait waistcoats in Bethlem now, or very few indeed; they generally use irons." The objection to strait waistcoats was, that the patients "could not help themselves in strait waistcoats; they are so excessively long in the hospital without being seen by anybody, in a dark place; in winter, from four o'clock to six or seven in the morning. If they were in a strait waistcoat they could not assist themselves the least in the world." When, in the following year, the head-keeper of Bethlem Hospital was asked, "Was it not the practice in old Bethlem—not in the late gallery, but in the gallery pulled down—for eight, ten, or more patients to be fastened to the tables, almost in a state of perfect nakedness?" he replied, "Yes; they used to think they tore their clothes all to pieces; some of them would do that." "In point of fact, were they not fastened to the tables, sitting in a state of perfect nudity?" Answer: "They used to be so at the table; they were chained all round." In regard to the apparatus, so ingeniously cruel, by which one of the patients (Norris) was chained ten or twelve years, Haslam, the apothecary at Bethlem, when asked, "Do you think that his confinement in that manner during the whole of that period was necessary?" replied, "Decidedly."

The matron of Bethlem Hospital (who was elected January, 1815) gave evidence that, when she was appointed, there were about twenty patients under personal restraint, out of between fifty and sixty patients. "The custom when I first went was only to get them up three days of the week—never on meat days; they lie in bed four days in the week." She also stated that one of the female patients had been chained for eight years, but had not required restraint since she had been there.

Bethlem, however, was far from being the only place where patients were treated like wild beasts. Mrs. Mary Humieres, formerly housekeeper in a private asylum at Bethnal Green, gave evidence to an attendant "kicking the patients and thumping them sadly," and "beating one in his shirt with a pair of boots, in a most dreadful manner." She named a female patient who, when in a state of irritation, "was confined in a place in the yard which was originally a pig-sty; it was run up high on purpose for her. I have seen her confined there for three weeks together. She has been ironed there in the crib with wrist-locks, and leg-locks, and a chain two or three times across her body." An iron bar was placed between her legs when she walked about, to prevent her escaping. "It was confined to each ankle, with a chain coming up between her legs, which was attached to her handcuffs." But, in addition to this frightful restraint, we are informed that an attendant, at the instance of the proprietor, would, "at sundry times," lock her down in her crib with wrist-locks and leg-locks, and horsewhip her. "I have seen the blood follow the strokes." Yet this patient is described as very harmless; "you might sit and talk to her when she was in the highest state."

The Committee found that at a private asylum—Fonthill, Wilts—there was in that year, out of fourteen patients, only one without fetters or handcuffs, and only three out of their sleeping-rooms.[146]

At the Bethnal Green Asylum "several of the pauper women were chained to their bedsteads, naked, and only covered with a hempen rug," and "the accommodation for paupers was infamously bad, and required immediate reform;" while in January of the same year it is reported that "some pauper men were chained upon their straw beds with only a rug to cover them, and not in any way defended from the external cold."[147]

Dr. John Weir was asked, at the Committee of 1815, to what he attributed the difference of opinion among even enlightened men as to the management of the insane. He replied that it was chiefly due to the want of practical observation, as it is only by comparison that we are enabled to appreciate the superiority of one institution over another. He added that, until within the last eighteen years, the primary object of almost every insane institution, whether of a public or private description, had been merely the security of these pitiable objects; comfort, medical and moral treatment, had been in a great measure overlooked. "Happily, however, for that class of society, the Retreat at York had at last convinced the world how much may be done towards the amelioration of their condition."[148]